Stem Cell Transplantation

Stem Cell Transplantation

What are Stem Cells?

Blood stem cells are produced in the bone marrow and can become any kind of blood cell the body needs. Stem cells are constantly dividing and maturing into different types of blood cells, replacing older and worn-out blood cells in the body. They produce billions of new blood cells every day. If the stem cells cannot make enough new blood cells, many serious health problems can occur. These problems may include infections, anemia or bleeding.

Healthy stem cells are needed to live. When cancer or cancer treatments destroy the stem cells, stem cell transplantation (SCT) may be the best treatment option.

What Is a Stem Cell Transplantation?

Before SCT, the patient receives high doses of chemotherapy, and sometimes radiation therapy, to prepare the body for transplantation. This is called "conditioning treatment." After the stem cells are infused into the patient’s bloodstream, they travel to the bone marrow and begin the process of forming new, healthy blood cells including white blood cells, red blood cells and platelets. This process is called “engraftment.”

Types of Stem Cell Transplantation

The main types of SCT are:

Autologous transplantation uses the patient’s own stem cells. These cells are removed, treated and returned to his or her own body after a conditioning regimen.

Allogeneic transplantation uses stem cells from a donor. A donor may be a family member or someone who is not related to the patient.

A syngeneic transplantation is much less common. Syngeneic transplantation is rare for the simple reason that it's only used on identical twins. In addition, the donor twin and the recipient twin must have identical genetic makeup and tissue type.

Are You a Candidate for Stem Cell Transplantation?

Stem cell transplantation has been used to cure thousands of people who have cancer, but there are serious risks to this treatment. Before undergoing stem cell transplantation, patients considering this treatment should discuss the risks and benefits with their doctors.

Not all patients are eligible for stem cell transplantation because not all patients can withstand the conditioning regimen and the side effects of treatment. Some patients also may not be eligible for standard transplantation if they have other major health problems. For some of these patients, however, a reduced-intensity allogeneic stem cell transplant may be a treatment option.

In order to determine if a patient is a good candidate for a stem cell transplantation, the patient’s healthcare team will consider

The patient’s general health and medical condition

The type and stage of cancer or disease

Prior treatment history

The likelihood that the disease will respond to the transplant

The availability of a suitable donor or the ability to use the patient’s own stem cells.

The risks of stem cell transplantation have decreased with the passing of each decade. Ongoing research is likely to continue to improve the procedure. For some diseases and patients, however, effective new drugs and new types of therapies may be better treatment options than stem cell transplantation. Doctors and their patients will consider many factors when deciding whether stem cell transplantation is the best treatment option.

Preparing for Transplantation

Medical Tests. Stem cell transplantation is a rigorous medical procedure. Before undergoing transplantation, patients will be given a number of medical tests to ensure that they are healthy enough for the procedure.

Caregiver. It is important for patients preparing for transplantation to choose a caregiver. Sometimes a caregiver is one person, but often several people can help at different times throughout the process. A caregiver should be with the patient all the time once the patient is discharged from the hospital in case unexpected complications arise and help is needed. Once the patient returns home, the caregiver will need to provide medical, emotional and daily support during recovery. Members of the patient’s healthcare team will teach the caregiver(s) the necessary skills to care for the patient.

Cost of Transplantation. Stem cell transplantation is a very expensive procedure. As soon as a stem cell transplant is being considered as a treatment option, patients should discuss financial issues with their treatment team. Transplant centers have staff members who can help patients to get answers for financial questions concerning health insurance and financial assistance.

Most insurance plans cover some of the costs of transplantation for certain cancers or diseases. Before undergoing transplantation, patients should contact their medical insurance providers and determine which costs the insurance provider will cover. If their insurance company denies coverage for a recommended treatment, procedure, or prescription medication, patients may be able to get the decision overturned by filing an appeal with their insurance company. If claims are repeatedly denied, patients may want to contact their state’s insurance agency or an attorney.

Fertility. High doses of chemotherapy and radiation can affect cells in both male and female reproductive systems. Recovery from stem cell transplantation may take months to years, and patients of childbearing age may not be physically or psychologically ready to think about parenthood for several years after transplantation. Patients who may want to have children in the future should discuss options to preserve fertility before transplantation.

Insertion of a Central Venous Catheter. During the transplantation process, a patient will need to have a number of intravenous (administered directly into a vein) infusions. In addition to the infusion of stem cells, patients may also receive other infusions, including fluids, chemotherapy, antibiotics, other drugs and transfusions of red blood cells and platelets. Patients will also need to have blood drawn frequently for testing to monitor their progress. These injections, if given individually, would be painful and the veins in the hands and arms could not sustain so many frequent needle pricks. Therefore, prior to the transplantation, patients will have a central line (central venous catheter [CVC]) inserted if they do not have one already. A CVC is a tube that is inserted through the skin into a large vein, usually in the upper chest. Placement is usually done under local anesthesia.

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